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Bridging the Gap: Transitioning into the Community as a Stroke Survivor Presented by: Meghan Foley MS OTR/L St. Luke’s University Hospital.

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Presentation on theme: "Bridging the Gap: Transitioning into the Community as a Stroke Survivor Presented by: Meghan Foley MS OTR/L St. Luke’s University Hospital."— Presentation transcript:

1 Bridging the Gap: Transitioning into the Community as a Stroke Survivor Presented by: Meghan Foley MS OTR/L St. Luke’s University Hospital

2 Objectives All clinicians will be able to identify community resources that are appropriate for patients based upon their co-morbidities, secondary diagnoses and deficits. Understand the different types of community resources and identify at least four of these resources that will allow patients to age in place. Identify at least two benefits for returning home with community resources

3 Statistics Stroke is the leading cause of long term disability in the United States 25% recover with minor impairments 40% experience moderate to severe impairments that require special care 10% require care in a nursing home or other long-term facility Approximately 14% of stroke survivors experience a second stroke in the first year following a stroke (Statistics, 2014).

4 Citation

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6 Lifeline Medical Alert “One out of three older adults (those aged 65 or older) falls each year” (cdc.gov) Lifeline offers a way for older individuals to SAFELY age in place Website provides Ebooks, Ebrochures

7 Lifeline Medical Alert Home Safe Standard Home Safe AlertGo SafeResponse App Features and Benefits Help at the press of a button in and around your home Maximum protection in and around your home Maximum protection at home and on the go Convenience for smartphone users Where it WorksIn and around your homeIn and around homeAnywhere with AT&T service Anywhere with smartphone What is Included  Pendant  24/7 Access response center  Communicator Unit  Pendant  24/7 Access response center  Communicator Unit Mobile Button Pendant  24/7 Access response center  Communicator Unit  Application  24/7 Access response center Automatic detection of falls NoYes No Location Capabilities Home Location on file 6 locationsPhone’s GPS Pricing$29.95/month$44.95/month One time button purchase of $ $54.95/month $13.95/month

8 Neuro-Ophthalmology “Approximately 30% of all stroke patients have visual impairment” (Marek & Antle). Neuro- Ophthalmologists provide treatment and diagnosis for individuals who experience the following due to brain or nervous system disorders: Abnormal eye movements (ophthalmoparesis or nystagmus) Visual Loss Diplopia Eye movement disorders Visual acuity loss Visual Field loss Intracranial lesions affecting the visual pathway Ischemic optic neuropathy Migraine and related visual complaints Optic disc swelling Optic neuritis Other optic nerve problems Pupillary abnormalities Unexplained vision loss Penn State Hershey Eye Center Penn Neuro-Ophthalmology William A. Cantore, M.D. Dr. Liu at HUP call Phone: or Dr Shindler or Dr. Tamhanker at Scheie Eye Institute call *for general appointments call patients seen within two weeks

9 Support Groups Stroke Club: held every 2nd Monday of the month at St. Luke’s Bethlehem Campus on CW 4th floor in the rehabilitation gym 3:30-4:30pm. For more information call: Caregiver Support Group: 3rd Saturday of each month at 11:00am in the Comfort Zone at St Luke’s Warren Campus. For more information call: Depression Support Group: 2nd and 4th Tuesday every month at 5:30-6:45pm in Priscilla Payne Hurd Education Center Rm 112 at St Luke’s Bethlehem Campus “Nearly 30% of stroke patients develop depression, either in the early or in the late stages after stroke” (Paolucci).

10 Tobacco Cessation Programs St Luke’s Tobacco Program - Personalized Quit Plan - Follow Up Telephone Counseling - Nicotine replacement therapy - Ways to cope with stress and nicotine cravings -Techniques to use to help prevent relapse St. Luke's Community Health th Avenue Suite 102 Bethlehem, PA Monday - Friday St. Luke's Care Now - Jim Thorpe St. Luke's Care Now - Jim Thorpe 1104 North St. Jim Thorpe, PA Tuesday Mornings Nesquehoning Family Health Center 108 West Catawissa St. Nesquehoning, PA Tuesday afternoon St. Luke's Family Health Center 1501 Lehigh Street Allentown, PA Thursdays Mercy Suburban Program Philadelphia, PA -Seven session program 1)Understanding addiction 2)Behavior change strategies 3)FDA medication options 4)Coping with urges 5)Stress 6)Healthy Lifestyle choices 7)Relapse prevention * Registration Required: Call “The risk of ischemic stroke in current smokers is about double that of nonsmokers after adjustment for other risk factors” (Marek & Antle).

11 Seniors Helping Seniors A unique program where seniors provide services to other seniors in their community 2 – 3 hour weekly check-in Services: companionship, light housekeeping, cooking, gardening, grooming/dressing, transportation, medication set up, Alzheimer’s and Dementia care, shopping, and overnight stays Locations Seniors Helping Seniors Lehigh Valley Phone: Seniors Helping Seniors Luzerne County Phone: Seniors Helping Seniors Western Montgomery and Upper Bucks County Phone:

12 Adult Day Programs Sarah Care Day Program Day program Provide transportation to and from the day program Evaluated quarterly by the director of nursing for a change in daily functioning Restorative nursing program available YMCA Bethlehem Monday-Friday 8:00am-5:00pm Adult 60+ years old Must arrange their own transportation Crafts, pet therapy, music therapy Location 3893 Adler Place Building B suite 180 Bethlehem, PA Other Adult Day Centers Care Institute of Technology Easton, Pa AMS Caregivers Emmaus, Pa Third Street Alliance: Easton, Pa Palmerton Hospital: Palmerton, Pa Lifespan Adult Day Center: Quakertown, Pa Westminster Village: Bethlehem, Pa The Comfort Warren Hospital Phillipsburg, NJ

13 Transport Services LantaVan Shared ride transportation program that services Lehigh and Northampton counties Door-to-door service 65+ pay 15% of fare If have Medical Access card eligible for MA reimbursable services Mon-Sat 5:30am-7pm and Sun 7am-7pm For more information call: Angel Flight Free air transportation for children and adults with medical conditions who need to get to treatment far from home Must be medically stable and able to board an aircraft For more information visit: or call

14 Adaptive Driving Good Shepherd Adaptive Driving Program - To qualify for the program individuals must be seizure free for 6 months, have state required vision quality, and be medically stable - A team of therapists, certified driver rehabilitation specialist and assistive technology professionals work with individuals who are older to obtain and maintain their drivers license 1) Clinical Assessment 2) Behind the Wheel 3) Van Evaluations 4) Transportation Evaluations 5) Training 6) Educations * Report sent to your physician, workman’s compensation, prescription for adaptive driving Robert & Marian Edwards Center Good Shepherd Center 850 South 5th St. Allentown, PA Phone: REHAB (73422) Mobility Works - Provides vehicle adaptations such as hand controls, wheelchair lifts, and transfer seat * Mechanical Hand Controls, Spinner Knobs, Electronic Hand Controls Location: 6475 Ruch Rd Bethlehem, PA Website:

15 Driving Assessments AAA Senior Driving Self Rating Tool: 15 questions self evaluation driving assessment to examine driving performance Interactive Driving Evaluation: Online access, to Roadwise Review exercises in the privacy of your home to see if visual, mental and physical conditions affect your driving skills and driving abilities. * FREE, CONFIDENTIAL self-evaluation based on both accuracy and speed of responses Website: Professional Assessment: is organized into two categories: 1) Driving Skills Evaluation: in-car evaluation of your driving abilities and a recommendation regarding any further specialized drivers' training 2) Clinical Driving Assessment: identify underlying medical causes of any driving performance deficits and offer ways to address them *Cost is approximately $100 to $200. Additional training sessions $ /hr *Contact your local AAA office for more information

16 Medication Management Approximately 30 percent of hospital admissions of older adults are drug related, with more than 11 percent attributed to medication nonadherence and 10–17 percent related to adverse drug reactions (ADRs) (Marek & Antle). Pill Organizer Boxes- Weekly set up of medications Several types of organizers (AM/PM, morning, noon, night, bedtime) Talking Pill Boxes: visually impaired Large print prescription bottles- visually impaired Simply label pill boxes Set alarms as reminder to take medications Automatic Refill of Medications In a study of elderly patients at 15 days post hospitalization, 27 percent had not filled their new prescriptions. Patients who participated in programs that provided pharmacy delivery and refill reminders had fewer adverse drug events and higher compliance than those who did not. (Marek & Antle). CVS Ready Fill - Create an account online or in store - Automatic Refill of medications - When medication runs out, CVS calls the doctor for a refill prescription **Offer medication delivery Wallgreens Pharmacy - Automatic Refills - Free Shipping or Pick Up in the store

17 Medication Assistance Programs voluntarily developed by manufacturers Financial assistance eligibility determined by each company Many require a prescription Private insurance, Medicaid or Medicare may disqualify individuals from this program Requirements for medication assistance programs: PACE: Income for single: $14,500 or less for married couple $17,700 or less PACENET: income for single $14,500-$23,500 for married couple $17,700-$31,500 - Must be 65 years and older - PA resident for 90 days Copies of the full directory of participating companies may be obtained by writing to: Pharmaceutical Manufacturer’s Association th Street NW Washington, DC OR State Representative Steve Samuelson at:

18 Mobility and Transfers Beasy Board Transfer Board Transfer Disc Lift Chair Hoyer Lift Sit to Stand Stair Glide

19 Ramp Companies Amramp - Specializes in modular steel wheelchair ramps, stair lifts, vertical platform lifts, free-standing lifts, pool lifts, and portable showers - Option to rent ramps - Free on site consultation - 48 hour set up Contact: Northeast Accessibility - Specializes in entrance ramps, stair lift and wheelchair lift installations, bathroom modifications, ceiling lifts, and electric scooters -Portable ramps are ideal for thresholds or as vehicle ramps - Also offer home safety evaluations Contact: Portable Shower

20 Types of Ramps Ceiling Lifts Portable Ramps Vertical Wheelchair Ramp Portable Car Ramp

21 Good Shepherd Wheelchair Clinic Third Friday of each month 8am-12pm Free service which offers wheelchair repairs: tightening, adjustment or evaluations for needed repairs No appointments necessary Location: Harry C. Trexler Center for Assistive Technology, Good Shepherd Health & Technology Center, 850 S. Fifth Street, Allentown Good Shepherd Health & Technology Center Sip and PuffTilt and SpaceStand up wheelchair

22 Good Shepherd Seating and Positioning Clinic RJ Foundation Mobility Center Seating/Positioning completed by therapy staff Evaluation includes: MMT, ROM, coordination, strength, and sensation. Balance transfers and ambulation is considered to identify the most appropriate seating system Computerized pressure mapping to identify appropriate pressure relief system (cushions) Not vendor specific The primary doctor is given the results of the assessment Various wheelchairs and seating systems are available to trial to determine the best seating system: Location: Harry C. Trexler Center for Assistive Technology Good Shepherd Health & Technology Center Good Shepherd Plaza 850 South 5th St. Allentown, PA Contact: Phone:

23 Bathing and Toileting Bath Lifts Shower Chair Grab Bars Shower Mat Drop Arm Commode Raised Toilet Seat Toilet Tongs Toilet Aid

24 Dressing and Grooming TED donner Sock Aid Dressing Stick Button Hook Toothpaste Holder Reacher Long Handled Comb Elastic Shoelaces

25 Universal Cuff Built Up/Angled Utensils Nosey Cup Can Opener Cutting Board Pot Stabilizer Scoop Dish Eating and Cooking

26 Sliding Scale payment based on income Meals Monday-Friday Weekend package available Grocery shopping service available Frozen Meals option No Age Limit! Do not have to be home bound! Varying diets available- including dysphagia levels Contact: Lehigh County or Northampton County Schuylkill County or Meals On Wheels

27 Online Grocery Shopping Weis Markets: Place order online at Select from one of two store locations: Cedar Crest Blvd Allentown, PA Crawford Drive, Bethlehem, PA *associates load groceries for carside pickup Giant: Peapod- in store pickup or delivery ShopRite: in store pickup or delivery Walmart Grocery: Delivery to your door, Choice of delivery times

28 Page Turner Card Holder Knitting loom Adaptive Leisure The Strong Arm Fishing Pole Head PointerAdaptive Shotgun

29 Sports Adaptations Adaptive Yoga: increased energy, flexibility, improved posture, pain management and increased tone and strength. Offered at Sojourn Adult Day Program and Joyful Noises Bicycling: Recumbent Bicycling Bowling: ramps Golfing: adaptive golf carts with swivel seats (allows almost a full stance and free swing

30 Adaptive Skiing Jack Frost/Big Boulder call extension Adaptive lessons on weekends only. Camelback Mountain lessons and state of the art equipment call Jeff McGinnis at the Pennsylvania Center for Adapted Sports,

31 Adaptive Swimming Sofao: adaptive swimming flotation chair equipped for individual with significant immobility. Features: hip, chest and head straps for proper positioning. Transfer Chairs Lifevests

32 Silver Sneakers Silver Sneakers 1 out of 5 people 65 or older is eligible for a SilverSneakers membership as part of a Medicare Advantage or Medicare Supplement Health plan Over 12,000 gyms nationwide Membership Includes: - Access to fitness equipment, pools and saunas - Access to HealthwaysFIT.com to help you track your health progress - Health education seminars and other events minute classes focusing on ROM, flexibility, strengthening, coordination, agility and endurance Home Exercise Programs available FLEX program Classes offered in community parks, recreation centers, and older adult living centers line dance and Latin dance, indoor and outdoor boot camp, walking groups Steel Fitness in Bethlehem, Bethlehem YMCA, Planet Fitness in Allentown, Hanover Township Community Center BOOM program: advanced fitness program for the active adult Fast pace, intense exercise programs ** Currently NOT offered in Pennsylvania https://www.silversneakers.com/

33 Pet Care Critter Care Plus - In Home Pet Sitting Services offered include: Dog Walking Plant care Newspaper/Mail pick up Contact: Fountain Hill: Allentown: Easton: No Worries Pet Sitting -In Home Pet Sitting Services offered include: Dog Walking Litter Box Care Bathing Nail Trimming Overnight Sitting Medication Administering Injections Pet Transportation Contact: NJ PA

34 Vocational Rehabilitation “Nearly one third of all strokes occur in individuals under the age of 65. Of those, 1 of 2 survivors will return to a full or part time job” (stroke.org)stroke.org Pennsylvania Office of Vocational Rehabilitation, or OVR, provides vocational rehabilitation services to help persons with disabilities prepare for, obtain, or maintain employment Individual Plans of Employment (IPE) are developed (objectives, responsibilities, and services OVR customers receiving Social Security benefits for their disability (SSI, SSDI) are exempt from OVR’s Financial Needs Test Trained professional vocational counselors that serve 67 counties Blind/Visual and Deaf/Hearing deficit services Allentown Reading Wilkes Barre 45 N. Fourth Street 3602 Kutztown Rd Suite G Laird Street Allentown, PA Reading, Pa Wilkes-Barre, Pa

35 Resources "Adaptive Lessons." Adaptive Lessons. N.p., n.d. Web. 15 Jan Adaptive Program." Pennsylvania Skiing. N.p., n.d. Web. 15 Jan "Angel Flight East." Angel Flight East. N.p., n.d. Web. 14 Jan "Family Empowerment: Adult Day Services Center." YWCA Bethlehem:. N.p., n.d. Web. 14 Jan “Fountain Hill, PA Pet and Animal Sitting." Pet and Animal Sitting Fountain Hill, PA Care Plus. N.p., n.d. Web. 14 Jan "Hand Controls, Electronic Driving Systems and Other Driving Aids." Hand Controls for Vans. N.p., n.d. Web. 14 Jan "LANtaVan." Lehigh and Northampton Transit Authority. N.p., n.d. Web. 14 Jan Marek KD, Antle L. Medication Management of the Community-Dwelling Older Adult. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 18. Available from: "Meals On Wheels | Delivering a Meal and a Smile….." Meals On Wheels. N.p., n.d. Web. 14 Jan ”Neuro-ophthalmology." Neuro-ophthalmology. N.p., n.d. Web. 14 Jan "Neuro-Ophthalmology." - Penn State Hershey. N.p., n.d. Web. 14 Jan "Northeast Accessibility::optimizing Personal Mobility Potential." Northeastaccessibility. N.p., n.d. Web. 15 Jan "OUR TIPS." No Worries Pet Sitting. N.p., n.d. Web. 14 Jan Paolucci, Stefano. "Epidemiology and Treatment of Post-stroke Depression." Neuropsychiatric Disease and Treatment. Dove Medical Press, n.d. Web. 14 Jan "Philips Lifeline." Lifeline. N.p., n.d. Web. 14 Jan

36 Resources et al. "Programs and Services." SarahCare of the Lehigh Valley Programs and Services Comments. N.p., n.d. Web. 14 Jan "Returning to Work After a Stroke." Stroke.org. N.p., 16 July Web. 15 Jan "Senior Driver Expo." SeniorDriving.AAA.com. N.p., n.d. Web. 14 Jan "Seniors Helping Seniors Lehigh Valley." At Home Care. N.p., n.d. Web. 14 Jan "Shepherd Center." Seating and Wheelchair Clinic. N.p., n.d. Web. 14 Jan "SilverSneakers.com." SilverSneakers.com. N.p., n.d. Web. 14 Jan "SOFAO." Spokes'n Motion. N.p., n.d. Web. 14 Jan "Statistics." Internet Stroke Center Stroke News. N.p., n.d. Web. 13 Jan "St. Luke's - Tobacco Cessation Treatment Center." St. Luke's -. N.p., n.d. Web. 14 Jan "Stroke Rehabilitation Information." : National Institute of Neurological Disorders and Stroke (NINDS). N.p., 13 Mar Web. 14 Jan "Stroke Facts." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 18 Aug Web. 13 Jan ”Vocational Rehabilitation Services." Vocational Rehabilitation. N.p., n.d. Web. 14 Jan http://www.dli.state.pa.us/portal/server.pt/community/vocational_rehabilitation/10356 "Wheelchair Ramps and More..." Amramp Makes Life Accessible. N.p., n.d. Web. 15 Jan http://www.amramp.com/


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